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Mind the gap in kidney care: translating what we know into what we do
Valerie A Luyckx1, Katherine R Tuttle2, Dina Abdellatif3
1Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Abstract:
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
Insights
Bridging the gap between kidney disease knowledge and practice is crucial. Early diagnosis and treatment, despite existing guidelines for risk factors like hypertension and diabetes, are significantly delayed by numerous barriers.
Area of Science:
- Nephrology
- Public Health
- Health Systems Research
Background:
- Significant delays exist in translating kidney disease treatments from clinical evidence to practice.
- Effective interventions for preventing and delaying kidney disease are underutilized.
- Kidney disease often progresses silently, leading to late diagnosis and treatment initiation.
Purpose of the Study:
- To highlight the critical need to accelerate the implementation of evidence-based kidney disease treatments.
- To identify and address systemic barriers hindering early diagnosis and management of kidney disease.
- To advocate for improved primary care integration for kidney disease prevention and treatment.
Main Methods:
- The study is a review and synthesis of current challenges in kidney disease care.
- Analysis of barriers at patient, clinician, health system, and societal levels.
- Emphasis on the gap between established guidelines and clinical practice.
Main Results:
- A substantial gap persists between kidney disease knowledge and its application in routine care.
- Underdiagnosis and undertreatment of common risk factors (hypertension, diabetes) contribute to kidney disease progression.
- Numerous barriers impede early detection and appropriate management, even in diagnosed patients.
Conclusions:
- Urgent action is required to narrow the gap between kidney disease knowledge and practice.
- Addressing systemic barriers is imperative for early diagnosis and effective treatment.
- Maximizing opportunities for early intervention, particularly at the primary care level, is essential to improve global kidney health.
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